epic-manual - Cognitive Aids for Peri operative Crises - V4.4 2022 Stanford Anesthes ia Cognitive Aid Program - Emergency Manual

Sep 23, 2026

Emergency manual with perioperative crisis cognitive aids organized for ACLS-related and other emergency events, including asystole/PEA, bradycardia, SVT, VFIB/VTACH, anaphylaxis, airway and fire scenarios, embolism, hemorrhage, airway pressure problems, spinal emergencies, hemodynamic instability, hypoxemia, electrolyte/toxin syndromes, malignant hyperthermia, pneumothorax, power failure, and post-arrest care. Provides task-and-actions checklists for crisis resources, immediate steps, CPR parameters, airway and IV access guidance, medication dosing, and differential diagnosis cues (e.g., H’s and T’s) with cross-references by numbered sections.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages60

Reading Time2 h 31 min

AccessFree to download

Asystole / PEA

Task, Actions, Crisis Resources

Treatment (CPR, Airway, IV Access, Meds, ECMO/CPB, Post Arrest)

Bradycardia

Task, Actions

Treatment (Pulse check, Airway, Stop Vagal Stimuli)

Other Crisis Sections (Numbered)

SVT (Unstable/Stable), VFIB/VTACH

Anaphylaxis, Bronchospasm, Delayed Emergence

Difficult Airway / Cric, Fire-Airway / Fire-Non-Airway

Embolism (Pulmonary), Hemorrhage

High Airway Pressure, High Spinal, Hypotension/Hypoxemia

Local Anesthetic Toxicity, Malignant Hyperthermia

Myocardial Ischemia, Oxygen/Power Failure

Pneumothorax, Right Heart Failure, Transfusion Reaction

Trauma, Crisis Resource Management

Emergency Manual Use, Infusion List

Cognitive Aids for Peri operative Crises - V4 .4 2022 Stanford Anesthes ia Cognitive Aid Program EMERGENCY MANUAL Phone List (Back Cover) | ACLS | | --- | | OTHER EVENTS | | RESOURCES | Asystole / PEA .................. 1 Bradycardia ..................... 2 SVT-Unstable and Stable ..... 3 VFIB / VTACH .................... 4 Anaphylaxis ..................... 5 Bronchospasm ................. 6 Delayed Emergence ............ 7 Difficult Airway / Cric .......... 8 Embolism-Pulmonary......... 9 Fire-Airway..................... 10 Fire-Non-Airway ............... 11 Hemorrhage .................... 12 High Airway Pressure .......... 13 High Spinal ...................... 14 Hypertension ................... 15 Hypotension .................... 16 Hypoxemia ...................... 17 Local Anesthetic Toxicity ..... 18 Malignant Hyperthermia ..... 19 Myocardial Ischemia .......... 20 Oxygen Failure ................. 21 Pneumothorax ................. 22 Power Failure ................... 23 Right Heart Failure ............. 24 Transfusion Reaction .......... 25 Trauma .......................... 26 Crisis Resource Management. 27 Emergency Manual Use ....... 28 Infusion List .................... 29 1 Asystole / PEA No pulse AND non-shockable rhythm on ECG e.g. asystole or any non-VFIB/VTACH Task Actions Crisis Resources • • Inform team •Identify leader Call a code • Call for code cart •Assign team member to read cognitive aid out loud TREATMENT | CPR | • Rate 100-120 compressions/min, minimize breaks
• Depth ≥ 5 cm; allow chest recoil; consider backboard
•Keep EtCO2 > 10 mmHg and diastolic BP > 20 mmHg
• Rotate compressors with rhythm check every 2 min. Place defibrillator pads. If becomes shockable VF/VT: defibrillate 200 J biphasic or 360 J monophasic

See VFIB/VTACH \#4
• Check pulse ONLY if signs of ROSC (sustained increased EtCO2, spontaneous arterial waveform, rhythm change)
• Prone CPR at lower edge of scapula OK ifairway secured
• Place defibrillator pads and check rhythm every 2 min | | --- | --- | | Airway | • 100% O2 10-15 L/min
• If mask ventilation: ratio 30 compressions to 2 breaths
• If airway secured: 10 breaths/min, tidal volume 6-7 mL/kg | | IV Access | • Ensure functional IV or IO access | | Meds | • Turn off volatile anesthetic and vasodilating drips
•Epinephrine 1 mg IV push every 3-5 minutes
• If hyperkalemia: calcium chloride 1 g IV; sodium bicarbonate 1 amp IV (50 mEq); regular insulin 5-10 units IV with dextrose/D50 1 amp IV (25 g)
• If acidosis: sodium bicarbonate 1 amp IV (50 mEq)
• If hypocalcemia: calcium chloride 1 g IV
• If hypoglycemia: dextrose/D50 1 amp IV (25 g) | | ECMO/CPB | • Consider ECMO or cardiopulmonary bypass | | Post Arrest • If ROSC: arrange ICU care and consider cooling | | Causes • Explore H’s and T’s on next page GO TO NEXT PAGE » Page 2 Asystole / PEA TEE / TTE and labs will aid diagnosis; Invite input from team Heart Rate-Vagal Stimulus • Desufflate abdomen • Remove surgical retractorsand sponges Hyperthermia See Malignant Hyperthermia \#19 Hypothermia DIAGNOSIS DIFFERENTIAL • Remove pressure from eyes, neck, ears, and brain. Drain bladder Hypovolemia • Give rapid IV fluid bolus • Check Hgb • If anemia or hemorrhage: See Hemorrhage \#12 • Consider relative hypovolemia: -If auto-PEEP: disconnect circuit -IVC compression -Obstructive or distributive shock See Anaphylaxis \#5 See High Spinal \#14 Hypoxemia • • • • O2 100% 10-15 L/min Check breathing circuit connections Confirm ETT placement with CO2 Check breath sounds • Suction ET tube • Consider chest x-ray; bronchoscopy See Hypoxemia \#17 Hydrogen Ions-Acidosis • Consider bicarbonate • Balance increasing ventilation with potential decrease in CPR quality Hyperkalemia • Calcium chloride 1g IV • Bicarbonate 1 amp IV (50 mEq) • In

FAQs

When should CPR pulse checks be performed in Asystole/PEA?

Check pulse only if there are signs of ROSC such as sustained increased EtCO2, spontaneous arterial waveform, or rhythm change. Otherwise proceed with CPR and rhythm reassessment.

What are the key CPR targets in the Asystole/PEA treatment section?

Provide CPR at 100–120 compressions/min with minimal breaks and depth ≥ 5 cm. Keep EtCO2 > 10 mmHg and diastolic BP > 20 mmHg, rotate compressors every 2 minutes, and apply/assess defibrillator pads.

How does the manual guide treatment for suspected hypoxemia during perioperative crises?

Use 100% O2 at 10–15 L/min and confirm breathing circuit connections and ETT placement with CO2. Verify breath sounds, suction the ET tube, and consider chest x-ray or bronchoscopy while cross-referencing the hypoxemia section.

Sep 23, 2026

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